Warming device

ABSTRACT

A warming device includes a clinical garment having an inside surface supporting a convective apparatus with comb-shaped, interleaved, separately inflatable sections, each adapted to enable a particular mode of warming.

U.S. patent application Ser. No. 11/899,928, filed Sep. 7, 2007,entitled “Perioperative Warming Device”.

BACKGROUND OF THE INVENTION

A warming device that may be used perioperatively includes a clinicalgarment and convective apparatus with multiple sections supported on theinside of the garment.

Convective devices that transfer heat to a human body are known. Forexample, there are devices that receive a stream of warmed pressurizedair, inflate in response to the pressurized air, distribute it within apneumatic structure, and emit the warmed air onto a body. These devicesare typically called “convective thermal blankets” or “covers”. ArizantHealthcare Inc., the assignee of this application, makes and sells suchthermal blankets under the BAIR HUGGER® brand. One such device is theModel 522 Upper Body Blanket.

Use of the term “convective” to denote the transfer of heat between awarming device and a body refers to the principal mode of heat transfer,it being understood that heat may at the same time be transferredbetween a convective warming device and a body by conduction andradiation, although not to the degree of convection.

Convective warming has been used with increasing frequency to prevent ormitigate hypothermia during medical treatment. However, with theexpansion of convective warming to treat core body cooling, it becomesapparent that it has manifold medical uses.

For example, a recent invention disclosed in the referenced PCTapplication adapts a clinical garment such as a robe or gown to receivea convective warming device in order to warm a person wearing thegarment in a clinical setting for comfort and mobility of the person.Arizant Healthcare Inc., the assignee of this application, makes andsells such warming devices under the BAIR PAWS® brand. These devices areintended to warm patients prior to surgery, and there is a need tofurther adapt such a combination for use perioperatively.

The term “perioperative” is defined in the PDR Medical Dictionary,Second Edition, (Medical Economics Company, 2000), as “around the timeof operation.” The perioperative period is characterized by a sequenceincluding the time preceding an operation when a patient is beingprepared for surgery (“the preoperative period”), followed by the timespent in surgery (“the intraoperative period”), and by the timefollowing an operation when the patient is closely monitored forcomplications while recovering from the effects of anesthesia (“thepostoperative period”).

According to Mahoney et al. (Maintaining intraoperative normothermia: Ameta-analysis of outcomes with costs. AANA Journal. April 1999; 67,2:155-164), therapeutic warming is employed during at least theintraoperative period in order to prevent or mitigate a constellation ofeffects that result from hypothermia. In fact, it is increasinglymanifest that maintenance of normothermia perioperatively enhances theprospects for a quick, successful recovery from surgery. Theeffectiveness of therapeutic warming depends upon delivery of enoughheat to a patient's body to raise the patient's core body temperatureto, or maintain it within, a narrow range, typically near 37° C. Thisrange is called “normothermic” and a body with a core temperature inthis range is at “normothermia.” Hypothermia occurs when the core bodytemperature falls below 36° C.; mild hypothermia occurs when core bodytemperature is in the range of 34° C. to 36° C. Therefore,“perioperative therapeutic warming” is warming therapy capable of beingdelivered during one or more of the perioperative periods for theprevention or treatment of hypothermia.

Therapeutic warming is contrasted with “comfort warming” which isintended to maintain or enhance a patient's sense of “thermal comfort”.Of course, therapeutic warming may also comfort a patient by alleviatingshivering or a feeling of being cold, but this is a secondary orancillary effect. And conversely, there may be a secondary or ancillarytherapeutic effect derived from the application of thermal comforttreatments such as the relief of patient anxiety. Thermal comfort is asubjective notion; however, the environmental conditions necessary toproduce a sense of thermal comfort in a population of human beings areknown and well tabulated. For example, Fanger (Thermal Comfort: Analysisand Applications of Environmental Engineering. Danish Technical press,Copenhagen, 1970) defines thermal comfort as “that condition of mindwhich expresses satisfaction with the thermal environment.” Even when apatient is normothermic, less than ideal environmental conditions canresult in acute feelings of discomfort. Under normothermic conditions,thermal comfort is largely determined with reference to skintemperature, not core body temperature. Comfort warming is warmingapplied to a patient to alleviate the patient's sense of thermaldiscomfort.

Therapeutic warming may be indicated during any one or more of theperioperative periods. For example, for a short operation in a surgerywith no warming equipment available, a person may be warmedpreoperatively in a preparation area to raise mean body temperature to alevel higher than normal in order to store enough thermal energy tomaintain normothermia, without heating, intraoperatively. After surgery,it may be necessary to apply therapeutic warming in a recovery area toraise the core temperature to normothermia and maintain it there for aperiod of time while anesthesia wears off. Alternatively, for a longsurgery in an arena with heating equipment available, a person may bewarmed for comfort before surgery and warmed therapeutically during andafter surgery.

Thermal blankets are typically used for therapeutic heating. An exampleis found in U.S. Pat. No. 6,524,332, “System and Method for Warming aPerson to Prevent or Treat Hypothermia”, commonly owned with thisapplication. Thermal blanket designs have converged on a lightweightinflatable structure made of a flexible material which distributeswarmed pressurized air over or against a permeable blanket surface thatfaces some portion of a patient's body and emits the distributed heatedair through small apertures or interstices in the surface.

Thermal blanket design has been adapted for comfort warming byconvective means such as those described in the referenced U.S. patentapplications, and the referenced Publication No. WO 03/086500.

When delivered by convective devices, therapeutic warming isdistinguished from comfort warming by intended effects and by theparameters of heat delivery that produce those effects. In this regard,a convective warming system typically includes a source of warmedpressurized air (also called a heater/blower unit, a forced air warmingunit, a heater unit, etc.), a convective device such as a thermalblanket (which is, typically, inflatable), and a flexible conduit or airhose connecting the heater/blower unit with the thermal blanket. Use ofsuch a system for a particular type of warming requires delivery ofwarmed air through a convective device at parametric values that achievea particular objective. The conditions by which a convective deviceproduces thermal comfort in normothermic individuals at steady state aresignificantly different from those necessary to treat hypothermia.Typically the conditions for thermal comfort are met in a system with arelatively low capacity heater/blower unit, while those in a therapeuticwarming system are achieved with a relatively high capacityheater/blower unit. The different capacities have led to use of airhoses with different capacities, with those delivering air flow forthermal comfort typically having smaller diameters than those serving atherapeutic warming requirement. The result is a divergence of designsleading to installation of different air delivery infrastructures fortherapeutic and comfort warming.

Health care cost is an issue of national importance. The cost of warmingperioperatively by convection is directly related to the number ofperioperative periods in which a person is warmed; the cost increaseswhen different convective warming apparatus are used in differentperiods to accomplish different goals. For example, when comfort andmobility are objectives of warming a person during the preoperativeperiod and therapy is the objective of warming during one or more of theintraoperative and postoperative periods, it is presently necessary touse different convective warming configurations. Manifestly, if oneconvectively-operating warming device could be used or adapted to beused perioperatively, significant savings in thermal care could berealized.

SUMMARY

In one aspect, a warming device capable of being used perioperativelyincludes a clinical garment having an inside surface supporting aconvective apparatus with multiple, comb-shaped, interleaved sections.At least one section is adapted for comfort warming and at least anothersection is adapted for therapeutic warming.

In another aspect, a warming device that may be used perioperativelyincludes a clinical garment and interleaved convective apparatus in anintegrated structure attached to the inside of the garment.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is an illustration of a person wearing a warming deviceconstituted of a clinical garment and a convective apparatus withmultiple sections mounted to the inside of the garment.

FIGS. 2A and 2B illustrate plan views of the warming device.

FIGS. 3A and 3B illustrate progressive stages of assembly of the warmingdevice.

FIGS. 4A and 4B are magnified partial sectional drawings illustratingconstruction of the convective apparatus.

FIGS. 5A-5C are plan views of alternate configurations for theconvective apparatus with multiple sections.

SPECIFICATION

A warming device that may be used perioperatively is constituted of aclinical garment and a convective apparatus with multiple sectionssupported on an inside surface of the garment. In this regard, a“clinical garment” is a garment that is typically used to temporarilyclothe a patient in a clinical setting. Such garments include hospitalgowns, robes, bibs and other equivalents. The clinical setting may be amedical or dental office or clinic, a hospital, or any facility orinstitution that provides medical or dental treatment to patients. Theconvective apparatus has multiple sections, preferably two separatesections. Each section may receive and distribute at least one stream ofwarmed pressurized air in a pneumatic structure and emit the air throughat least one permeable surface to thereby convectively warm a personwearing the clinical garment. One section is adapted for comfort warmingby convection, the other for therapeutic warming by convection.

In one aspect, a warming device capable of perioperative use may be wornon a person where it receives a first stream of warmed pressurized airin one section of the convective apparatus, distributes the pressurizedair within the one section, and emits the air through a permeablesurface of the one section to convectively warm the person's body forcomfort. In another aspect, a warming device capable of perioperativeuse may be worn on a person where it receives a second stream of warmedpressurized air in the other section of the convective apparatus,distributes the pressurized air within the other section, and emits theair through a permeable surface of the other section to convectivelywarm the person's body for therapy. Preferably, the permeable surfacesare respective sections or regions of the same surface. Further,although not necessary to the practice of this warming device, thepermeable surfaces may have differing or varied permeabilities in orderto optimize the effects produced by the sections of the convectiveapparatus.

In the warming device illustrated and discussed below, each of thesections of the convective apparatus is inflatable. That is, thestructure of each section, flaccid when not in use, tautens whenreceiving a stream of pressurized air.

Refer now to FIG. 1 in which a person 10 wearing a warming device 12that may be used perioperatively is shown. The warming device 12 isconstituted of a clinical garment 13 and a convective apparatus 15 withmultiple sections that is supported on an inside surface of the clinicalgarment 13. The convective apparatus has for example two separatesections, each of which has at least one inlet port through which thesection may receive warmed pressurized air from a heater/blower unit(not seen). Each inlet port is accessible through an aperture in theclinical garment 13. For example one inlet port for one of the sectionsmay be accessed through a flap 18 in the clinical garment. An inlet portof another section may be accessed by releasing and folding down aportion 20 of the clinical garment. This latter form of access isillustrated in FIG. 1 where an air hose 21 with a nozzle 23 is receivedin an inlet port of one section of the convective apparatus. In thiscase, the portion 20 of the clinical garment comprises a portion of theupper edge and left sleeve that may be held to an opposing portion ofthe clinical garment by opposing strips of hook-and-eye material. Ofcourse, this other inlet port may also be accessed through a flap suchas the flap 18 instead of a folded-down garment section. Yet anothermeans of accessing the inlet port for the other section would be toprovide perforations in the nearest sleeve.

Convective apparatus such as thermal blankets have been specificallydesigned for particular uses. For example, a full body thermal blanketis adapted to lie upon the person and to extend longitudinally along thebody of the person in order to cover substantially the person's entirebody, from near the ankles or feet up to the neck. A lower body thermalblanket is adapted to lie upon the person and to extend longitudinallyalong the body of a person in order to cover the person's lower body,from near the ankles or feet up to the waist or pelvis of the person. Anupper body thermal blanket has a bow-tie shape that is adapted to lieupon and extend transversely across the upper body of a person in orderto cover the person's chest and extended arms. When fed a stream ofwarmed pressurized air, each of these thermal blankets inflates anddistributes the air within itself. The pressurized air flows throughapertures on a permeable surface of the thermal blanket which faces theperson. These thermal blankets may have one, two, or more inlet portsthrough which an air hose provides warmed pressurized air from aheater/blower unit. The construction of thermal blankets is wellunderstood. Examples of specific constructions are given in U.S. Pat.No. 5,620,482, U.S. Pat. No. 5,443,488, U.S. Pat. No. 5,360,439, andU.S. Pat. No. 5,304,213.

Typically, convective warming products are designed to provide a singlemode of warming. Each of the thermal blankets described above isdesigned for therapeutic warming. The devices described in publicationWO 03/086500 are designed for comfort warming. In contrast, the warmingdevice described in this specification may provide either therapeuticwarming or comfort warming, depending on the need. One section of theconvective apparatus is constructed to receive air at low flow rates inorder to provide comfort heating at steady state. Another section isconstructed to receive air at higher flow rates in order to providetherapeutic heating at steady state.

A convective apparatus 15 with multiple sections is illustrated in FIGS.2A and 2B. In FIG. 2A the convective apparatus 15 is shown disposedinside the outline of the clinical garment 13; in FIG. 2B, theconvective apparatus 15 is shown in plan view looking toward a permeablesurface of the convective apparatus 15. The convective apparatus 15 hasa “Tee” shape with a thick base 27 and an elongate top 28 which isperpendicular to the base 27. The elongate top 28 extends transverselyacross a longitudinal axis 21 of the clinical garment 13, between and atleast partly into the sleeves 22 of the clinical garment 13. The base 27is substantially centered on the longitudinal axis 21. The elongate top28 has portions 29 on either side of the base 27. Each of the portions29 protrudes at least part way into a respective sleeve 22 of theclinical garment 13.

The convective apparatus 15 has multiple sections. A “section” of theconvective apparatus 15 is a portion or division of the convectiveapparatus 15 that may be inflated and operated separately from any othersection of the convective apparatus 15. For example, the convectiveapparatus 15 has a section 32 and a section 42. The section 32 may beinflated and operated separately from the section 42, and the section 42may be inflated and operated separately from the section 32. The section32 has an inlet port 34, an elongate transverse part 36, and a pluralityof elongate parts 37 that connect perpendicularly to the transverse part36. Each of the two outermost elongate parts 37 transitions through anoutward 90° bend to a sleeve portion 38. Each sleeve portion 38 is in arespective portion 29 of the convective apparatus 15. Although one inletport 34 is illustrated in the section 32, one or more additional inletports may be provided for convenience. Unused inlet ports are sealed orclosed by known means to prevent air escaping therethrough. Preferablythe inlet port 34 is provided through the side of the convectiveapparatus 15 which is not visible in this figure; it may also beprovided through an edge of the convective apparatus 15. The inlet port34 may comprise a collar 34 a of stiff material with an opening 34 b toreceive the nozzle of an air hose, or it may comprise a sleeve ofmaterial, or any other equivalent structure. The space in the transversepart 36 is in fluid communication with the spaces in the elongate parts37 so that pressurized air flowing through an inlet port into thetransverse part 36 flows also into the elongate parts 37, therebyinflating the section 32. The surface of the section 32 which is visiblein FIG. 2, including the surfaces of the transverse part 36 and theelongate parts 37, is permeable, permitting pressurized air that isflowing into and inflating the section 32 to be expelled toward theinterior of the clinical garment 13.

The section 42 has an inlet port 44, an elongate transverse part 46, anda plurality of elongate parts 47 that connect perpendicularly to thetransverse part 46. The elongate transverse part 46 is parallel andadjacent to the sleeve portions 38 of the section 32. The end portionsof the elongate part 46 are in respective portions 29 of the convectiveapparatus 15. The elongate parts 47 of the section 42 are interleavedwith the elongate parts 37 of the section 32, thereby forming anintegrated convective apparatus 15 with dual sections. Although oneinlet port 44 is illustrated in the section 42, one or more additionalinlet ports may be provided for convenience. Unused inlet ports aresealed or closed by known means to prevent air escaping therethrough.Preferably the inlet port 44 is provided through the side of theconvective apparatus 15 which is not visible in this figure; it may alsobe provided through an edge of the convective apparatus 15. The inletport 44 may comprise a collar 44 a of stiff material with an opening 44b to receive the nozzle of an air hose, or it may comprise a sleeve ofmaterial, or any other equivalent structure. The space in the transversepart 46 is in fluid communication with the spaces in the elongate parts47 so that pressurized air flowing through an inlet port into thetransverse part 46 flows also into the elongate parts 47, therebyinflating the section 42. The surface of the section 42 which is visiblein FIG. 2, including the surfaces of the transverse part 46 and theelongate parts 47, is permeable, permitting pressurized air that isflowing into and inflating the section 42 to be expelled toward theinterior of the clinical garment 13.

The inlet port 34 of the section 32 has a smaller opening 34 b than theopening 44 b through the inlet port 44 of the section 42. Consequently,the inlet port 34 accepts an air hose nozzle with a smaller diameterthan the air hose nozzle diameter accepted by the inlet port 44. Thesmaller nozzle diameter signifies a comfort warming air supply with anair hose having a smaller diameter than the air hose of a therapeuticwarming air supply. Further, the smaller air hose may be coupled to aheater blower unit with a smaller capacity than that of the heaterblower unit of the therapeutic warming air supply. The smaller-diameter,smaller-capacity comfort warming air supply ensures that the section 32operates in response to a heater/blower unit designed for comfortwarming while the larger-diameter, higher-capacity therapeutic airsupply ensures that the section 42 operates in response to aheater/blower unit designed for therapeutic warming.

FIGS. 3A and 3B illustrate assembly of a perioperative warming deviceconstituted of the clinical garment 13 and the convective apparatus 15with multiple sections. The convective apparatus 15 is adapted to beattached to, received on, supported on or constructed on the insidesurface 52 of the clinical garment 13. The clinical garment 13 has atleast one flap 18 through which an inlet port of one section may beaccessed. For example, the flap 18 provides access to the inlet port 34for receiving and retaining the nozzle of an air hose through whichwarmed pressurized air may be provided at a temperature and a capacity(in ft³ per minute) to provide comfort warming for a person wearing theclinical garment 13.

Refer to FIGS. 2B, 3B, and 4 for an understanding of how the convectiveapparatus 15 may be constructed by joining two sheets of material, onepermeable to permit warmed pressurized air to be emitted through thesheet, the other impermeable. With reference to FIGS. 2B and 3B, theimpermeable sheet faces the clinical garment 13, while the permeablesheet faces the interior of the clinical garment 13. The convectiveapparatus 15 may be constructed as a separate piece and then attached tothe inside surface 52 of the clinical garment 13 with the impermeablesheet against the inside surface 52, or it may be constructed integrallywith the clinical garment by using a portion of the clinical garmentitself as one of the sheets of the convective device. For example, withreference to FIGS. 2B and 4 two sheets 114 and 116 of flexible materialare joined by a single substantially continuous seal 70 along theperiphery of the convective apparatus 15, and also by a continuous seal72 that separates the sections of the convective apparatus and definesthe parts of each section. The seal 70 is interrupted at the ends of thetransverse part 46 to provide vents 74 in the peripheral edge of theconvective apparatus 15 through which warmed pressurized air can flowfrom the convective apparatus 15 into the sleeves 22 for warming thearms during therapeutic warming. Similarly, the seal 70 is interruptedat the ends of the sleeve portions 38 to provide vents 74 in theperipheral edge of the convective apparatus 15 through which warmedpressurized air can flow from the convective apparatus 15 into thesleeves 22 for warming the arms during comfort warming. The sheets maybe further joined at multiple stake points within the periphery.Depending upon the materials selected, seals and stake points may bemade for example by sewing, gluing, heating, or ultrasonically bondingthe sheets along the seals, or by combinations thereof, or by anyequivalent process.

Either or both of the sheets 114 and 116 may be a single sheet or mayhave a laminate structure. A laminate sheet structure may include alayer (114 a, 116 a) of extruded synthetic material lined with a layer(114 b, 116 b) of non-woven material. If the permeable sheet has alaminate structure, holes or apertures 132 are formed through bothlayers 114 a, 114 b of the sheet 114 to provide a permeable surfacethrough which warmed pressurized air can be emitted toward the interiorof the clinical garment 13. In FIG. 4A, the sheets 114 and 116 areoriented to have the extruded layers (114 a and 116 a) facing, and theseals 70, 72 are formed by a gluing process or by a heating orultrasonic process acting through one of the layers of non-wovenmaterial. Once constructed, the convective apparatus 15 may be attachedto the inside surface 52 of the clinical garment by mechanisms 150.

In FIG. 4B, the sheet 114 may be a laminate structure as describedabove. If the clinical garment 13 is a woven cloth, such as cotton, or anon-woven such as spunbond-meltblown-spunbond material (SMS), the seals70, 72 between the portion of the garment's inside surface 52 and theextruded layer of the laminate sheet may be formed by a gluing, aheating, or an ultrasonic process acting between the inside surface andthe sheet 114.

Another construction of the convective apparatus 15 may use a singlesheet of permeable material in which the apertures are interstices inthe material structure. For example with reference to either FIG. 4A orFIG. 4B, the impermeable layer 114 a may be eliminated on the conditionthat the layer 114 b be a permeable material capable of being sealed tothe impermeable layer 116 a or the woven cloth of the clinical garment.

Yet another alternative construction of the convective apparatus 15 isto construct the clinical garment 13 of a laminate sheet 116 and seal anapertured laminate sheet 114 or a single permeable layer 114 b of wovenor non-woven material thereto.

In yet another construction, the convective device may be constituted ofan impermeable layer sealed around its periphery to the outside surfaceof the clinical garment so that the pneumatic structure is disposed onthe outside of the clinical garment. In this case apertures are providedthrough the portion of the clinical garment beneath the impermeablelayer.

Of course the sections of the convective device may be fabricatedseparately and placed on the inside surface 52 in the interleavedrelationship shown in FIGS. 2A and 2B.

Examples of non-woven material include any one or more of polyester,cotton, rayon, polypropylene, and wood pulp. Examples of extrudedsynthetic material include polypropylene, polyesters, and polyurethanes.Polyolefin plastics, including polyethylene, may provide the bestresults in terms of manufacturability since both woven and extrudedmaterials may be made from them. Examples of attachment materials andmechanisms 150 by which the convective apparatus 15 as presented in FIG.4A can be attached to the inside surface 52 include two-sided adhesive,hook and loop, sewing, snaps, heat, ultrasonic, rivets, and any and allequivalents thereof.

As best seen in FIGS. 3A and 3B, the clinical garment 13 may be astandard gown, a modified gown or a special purpose gown. The gown mayhave a rear opening, a front opening or other suitable openings, such asa head opening in a poncho type gown. One type of gown shown in thefigures has a rear opening. For example, in FIGS. 3A and 3B the gown 13has a slit 170 that extends from the neck portion 154 to a hemline 155.A fastening means is provided to provide for ease in securing the gownto the patient as well as allowing for ease in adjusting the size of thegown to accommodate various different-sized wearers. FIG. 3A shows onemethod using hook and eye buttons 171 a, 171 b positioned along opposingsides of the slit 170 a, 170 b that can be brought together and fastenedto hold the gown to the patient. Another method of attachment, shown inFIG. 3B, is a plurality of strings 172 positioned along opposing sidesof the slit 170 that can be tied together to hold the gown to a patient.Other methods of attachments include hook and eye elements, double-sidedadhesive, snaps, rivets, and any and all equivalents thereof.

The clinical garment 13 may include sleeves 22 that are sized andpositioned for receiving a patient's arms. Two examples of such sleeves22 are shown in the figures. In FIGS. 3A-3B the sleeve portions 175 areslit the entire length on the shoulder or top 177. This allows access tothe upper body of the patient and the inlet port 44 and allows foropening and closing of the slit sleeves 22 in an adjustable fashionusing buttons, snaps, repositionable adhesive, hook and eye elements,double-sided adhesive, hook and loop, rivets, and any and allequivalents thereof. The design shown in FIG. 3A also facilitates themanufacturing of the clinical garment 13 in one piece.

As best seen in FIGS. 2A and 2B, to secure the convective apparatus to apatient, a strip 180 of double sided adhesive is adhered to thetransverse part 42. During use of the perioperative warming device 12, arelease liner may be removed from a surface of the strip 180 facing thepatient and adhered to the patient to prevent unintended movement of theconvective apparatus 15 during warming.

Other configurations of the convective apparatus with multiple sectionsmay be more useful for particular applications or may be more amenableto particular manufacturing architectures and/or processes than theconfigurations shown and discussed above; FIGS. 5A-5C illustrate threealternative configurations. Each of these figures is a schematicillustration of a convective apparatus with multiple sections presentedagainst an outline of the clinical garment 12. The view in each case isinto the clinical garment, toward the inside surface. Accordingly, thepermeable surfaces of the sections of the convective devices are visiblein each drawing.

In FIG. 5A, the warming device 12 includes the clinical garment 13 and aTee-shaped convective device 65 with multiple sections is illustrated.For example, the convective device has two sections, a section 67 and asection 68. The section 67 may be inflated and operated separately fromthe section 68, and the section 68 may be inflated and operatedseparately from the section 67. The section 67 has an elongatecomb-shaped outline, with the teeth of the comb oriented generallytransversely across the inside surface 52. The section 67 has an inletport 69 (accessible through the front of the clinical garment 13). Thesection 68 has a comb-shaped lower part, with the teeth of the comboriented generally transversely across the inside surface 52 andinterleaved with the teeth of the section 67. The section 68 also has atransverse part that extends between and at least partially into sleeves22 of the clinical garment 13. The section 68 has an inlet port 70(accessible through the front of the clinical garment 13). Preferably,the section 67 may be used for comfort warming by convection, while thesection 68 may be used for therapeutic warming by convection. In thislatter regard the larger pneumatic structure and larger area of thepermeable surface of the section 68 afford a higher capacity in ft³ perminute for warming than the section 67.

In FIG. 5B, the warming device 12 includes the clinical garment 13 and aconvective device 75 with multiple sections is illustrated. For example,the convective device has two sections, a section 77 and a section 78.The section 77 may be inflated and operated separately from the section78, and the section 78 may be inflated and operated separately from thesection 77. The section 77 has an elongate comb-shaped outline, with theteeth of the comb oriented generally transversely across the insidesurface 52. The section 77 has an inlet port 79 (accessible through thefront of the clinical garment 13). The section 78 has a comb-shapedlower part, with the teeth of the comb oriented generally transverselyacross the inside surface 52 and interleaved with the teeth of thesection 77. The section 78 also has a notched upper part that does notextend between the sleeves of the clinical garment 13. The section 78has an inlet port 80 (accessible through the front of the clinicalgarment 13). Preferably, the section 77 may be used for comfort warmingby convection, while the section 78 may be used for therapeutic warmingby convection. In this latter regard the larger pneumatic structure andlarger area of the permeable surface of the section 78 afford a highercapacity in ft³ per minute for warming than the section 77.

In FIG. 5C, the warming device 12 includes the clinical garment 13 and aconvective device 85 with multiple sections is illustrated. For example,the convective device has two sections, a section 87 and a section 88.The section 87 may be inflated and operated separately from the section88, and the section 88 may be inflated and operated separately from thesection 87. The section 87 has an upright comb-shaped outline, with theteeth of the comb oriented generally upwardly along the middle of theinside surface 52. The section 87 has an inlet port 89 (accessiblethrough the front of the clinical garment 13). The section 88 has acomb-shaped part, with the teeth of the comb oriented generallydownwardly along the inside surface 52 and interleaved with the teeth ofthe section 87. The section 88 also has a notched upper part that doesnot extend between the sleeves of the clinical garment 13. The section88 has an inlet port 90 (accessible through the front of the clinicalgarment 13). Preferably, the section 87 may be used for comfort warmingby convection, while the section 88 may be used for therapeutic warmingby convection. In this latter regard the larger pneumatic structure andlarger area of the permeable surface of the section 88 afford a highercapacity in ft³ per minute for warming than the section 87.

In use, a person may be warmed perioperatively using a warming deviceconstituted of a clinical garment and a dual-section convectiveapparatus supported on an inside surface of the clinical garment bydressing a person with the clinical garment during the preoperativeperiod, coupling a first section (the section 32 in FIG. 2B, forexample) of the convective apparatus to a source of warmed pressurizedair for comfort warming, and convectively warming the person for comfortby way of the first section. To prepare for surgery, the first sectionis decoupled from the comfort warming source and the clinical garment isarranged to afford access to a surgical site. In preparation forsurgery, the clinical garment may be left on the person, with its skirtsrolled up to provide surgical access. Alternatively, the clinicalgarment may be removed to allow the convective apparatus to bepositioned on the person to provide surgical access. In this lattercase, the skirts, sleeves and other loose parts of the clinical garmentmay be rolled or folded onto the convective device. In yet anotheralternative, if the convective device is releasably attached to theinside surface of the clinical garment, the garment may be separatedfrom the convective device during surgery and reattached laterpostoperatively. During surgery, the convective device may be secured tothe person by means of the double sided adhesive and a second section ofthe convective apparatus (for example the section 42 in FIG. 2B) may becoupled to a source of warmed pressurized air for therapeutic warming,and the person may be convectively warmed for therapy by way of thesecond section. Following surgery, the convective apparatus is detachedfrom the person (but only if secured to the person for surgery), theconvective apparatus is reattached to the clinical garment (but only ifdetached therefrom for surgery), the person is again dressed with theclinical garment and either warmed for comfort or warmed for therapy.

Manifestly, the descriptions and illustrations in this specification arepresented for an understanding of how to make and use an exemplarywarming device. The only limitations on the scope of protection affordedthe inventive principles presented are in the following claims.

1. A warming device, comprising: a clinical garment with an insidesurface; and, a convective apparatus supported on the inside surface;the convective apparatus including first and second sections, the firstand second sections being separately inflatable, and each sectionincluding a permeable surface facing the interior of the clinicalgarment; the first section having an elongate comb-shaped outline withteeth and including at least one inlet port; and, the second sectionhaving an elongate comb-shaped outline with teeth interleaved with theteeth of the first section and including at least one inlet port.
 2. Thewarming device of claim 1, the first section including a pneumaticstructure and a permeable surface area adapted for comfort warming, andthe second section including a pneumatic structure and a permeablesurface adapted for therapeutic warming.
 3. The warming device of claim2, the clinical garment further including sleeves and the second sectionfurther including a transverse part extending between and at leastpartially into the sleeves.
 4. The warming device of claim 2, theclinical garment further including sleeves and the second sectionfurther including an upper part that does not extend between thesleeves.
 5. The warming device of claim 1, the clinical garment being ahospital gown.
 6. The warming device of claim 1, the clinical garmentbeing a robe.
 7. The warming device of claim 1, the clinical garmentbeing a bib.
 8. The warming device of claim 1, the clinical garmentbeing a poncho-type gown.
 9. A warming device, comprising: a clinicalgarment with an inside surface; and a tee-shaped convective apparatussupported on the inside surface; the convective apparatus including dualsections adapted to provide comfort warming and therapeutic warming byconvection, the dual sections being separately inflatable, and eachsection including a permeable surface facing the interior of theclinical garment; a first section having an elongate comb-shaped outlinewith the teeth of the comb oriented transversely across the insidesurface, and including at least one inlet port; and, a second sectionincluding an upper transverse part, a lower part having an elongatecomb-shaped outline with the teeth of the comb oriented transverselyacross the inside surface, and at least one inlet port; wherein, theteeth of the first and second sections are interleaved.
 10. The warmingdevice of claim 9, the first section including a pneumatic structure anda permeable surface area adapted for comfort warming, and the secondsection including a pneumatic structure and a permeable surface adaptedfor therapeutic warming.
 11. The warming device of claim 9, the clinicalgarment being a hospital gown.
 12. The warming device of claim 9, theclinical garment being a robe.
 13. The warming device of claim 9, theclinical garment being a bib.
 14. The warming device of claim 9, theclinical garment being a poncho-type gown.
 15. A warming device,comprising: a clinical garment with an inside surface and sleeves; and aconvective apparatus supported on the inside surface; the convectiveapparatus including a first and second sections, the first and secondsections being separately inflatable and each including a permeablesurface facing the interior of the clinical garment; the first sectionhaving a comb-shaped outline with teeth, and including at least oneinlet port; and, the second section including an upper part that doesnot extend between the sleeves, a lower part having a comb-shapedoutline with teeth interleaved with the teeth of the first section, andat least one inlet port.
 16. The warming device of claim 15, wherein theteeth of the first and second sections are oriented transversely acrossthe inside surface.
 17. The warming device of claim 16, wherein theupper part of the second section is notched.
 18. The warming device ofclaim 16, the first section including a pneumatic structure and apermeable surface area adapted for comfort warming, and the secondsection including a pneumatic structure and a permeable surface adaptedfor therapeutic warming.
 19. The warming device of claim 15, wherein theteeth of the first section are oriented upwardly along the insidesurface and the teeth of the second section are oriented downwardlyalong the inside surface.
 20. The warming device of claim 16, whereinthe upper part of the second section is notched.
 21. The warming deviceof claim 15, the first section including a pneumatic structure and apermeable surface area adapted for comfort warming, and the secondsection including a pneumatic structure and a permeable surface adaptedfor therapeutic warming.
 22. The warming device of claim 15, theclinical garment being a hospital gown.
 23. The warming device of claim15, the clinical garment being a robe.
 24. The warming device of claim15, the clinical garment being a bib.
 25. The warming device of claim15, the clinical garment being a poncho-type gown.